摘要
目的总结分析老年退行性心脏瓣膜病(SDHVD)的临床特点及误诊原因、防范措施。方法对2020年1月—2022年12月收治的曾在外院误诊的SDHVD 15例的临床资料进行回顾性分析。结果15例中单纯主动脉瓣病变8例,二尖瓣病变5例,主动脉瓣及二尖瓣双病变2例;有高血压病史8例,高脂血症史6例,2型糖尿病史4例,慢性阻塞性肺疾病史3例,脑卒中史2例;有吸烟史7例。10例因伴不同程度心悸、胸闷、气促、乏力及心前区闷痛,初步诊断为冠心病;5例因伴不同程度心悸、胸闷、气促、乏力及下肢水肿,听诊发现心脏杂音,初步诊断为风湿性心脏病。误诊时间0.5~2个月。初步诊断为冠心病者予药物治疗症状未见缓解就诊我院;初步诊断为风湿性心脏病者未予任何治疗转我院进一步诊治。15例就诊我院后,根据临床表现和高压断层X线检查、心脏超声心动图检查等,确诊为SDHVD。6例行介入治疗,后失访;9例行药物保守治疗,随访1年病变瓣膜钙化情况控制较好。结论SDHVD病初常无明显症状,或症状轻微被老年基础疾病症状所掩盖,加之部分患者心脏瓣膜杂音缓慢发展,易误诊。提高接诊医生对本病的认知、丰富其诊断及鉴别诊断经验,及早行高压断层X线及超声心动图等检查,有利于减少或避免本病误诊误治。
Objective To summarize and analyze the clinical characteristics,causes of misdiagnosis and preventive measures for senile degenerative heart valvular disease(SDHVD).Methods Clinical data of 15 patients with SDHVD admitted to our hospital from January 2020 to December 2022 after misdiagnosis in other hospitals were retrospectively analyzed.Results Among the 15 patients,there were 8 patients with simple aortic valve disease,5 patients with mitral valve disease,and 2 patients with double aortic and mitral valve disease.Past medical history included hypertension(n=8),hyperlipidemia(n=6),type 2 diabetes(n=4),chronic obstructive pulmonary disease(n=3),and stroke(n=2).There were 7 patients with smoking history.Ten patients were initially diagnosed as coronary heart disease(CHD)due to different degrees of palpitation,chest tightness,shortness of breath,weakness and pain in the precordial area.For 5 patients with different degrees of palpitation,chest tightness,shortness of breath,weakness and lower limb edema,auscultation found heart murmur,preliminary diagnosis of rheumatic heart disease was made.The misdiagnosis lasted 0.5 to 2 months.For the patient initially diagnosed with CHD the symptoms did not show significant relief after drug treatment.Patients with initial diagnosis of rheumatic heart disease did not receive any treatment and were referred to our hospital for further treatment.After the 15 patients were admitted to our hospital,according to clinical manifestations,high-pressure X-ray tomography and echocardiography examination,SDHVD was confirmed.Six patients were treated with interventional therapy and then lost to follow-up,and 9 patients were given conservative drug therapy,and calcification of the damaged valve was well controlled at 1-year follow-up.Conclusion There are usually no obvious symptoms in the early stage of SDHVD,or the symptoms are slightly covered by the symptoms of the underlying diseases of the elderly.In addition,some patients have the characteristics of slow development of heart valve murmurs,often resulting in misdiagnosis.To improve the receiving doctors'cognition of the disease,enrich their experience in diagnosis and differential diagnosis,and perform high-pressure X-ray tomography and echocardiography as soon as possible is necessary to reduce or avoid misdiagnosis and mistreatment of this disease.
作者
王华君
闫芳
郎泽飞
孙涌泉
郭艳慧
安景辉
WANG Huajun;YAN Fang;LANG Zefei;SUN Yongquan;GUO Yanhui;AN Jinghui(Department of Cardiac Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050004,China)
出处
《临床误诊误治》
CAS
2024年第2期7-12,共6页
Clinical Misdiagnosis & Mistherapy
基金
河北省医学科学研究课题(20230440)。
关键词
心脏瓣膜疾病
退行性
老年人
误诊
冠心病
风湿性心脏病
高压断层X线检查
超声心动描记术
Heart valve diseases
Degenerative
Elderly
Misdiagnosis
Coronary heart disease
Rheumatic heart disease
High-pressure X-ray tomography
Echocardiography
